In this episode, we again explore the world of the distal perfusion catheter. You heard from Joe Dubose the vascular surgeons point of view; now let's see how non-surgeon resuscitationists are dealing with this problem. You will hear from Chris Couch, a critical care trained emergency physician from Dallas Texas and his colleague Omar Hernandez who have some novel thoughts and experiences related to when and how we insert these catheters. You will hear about checking compartment pressures, poor man's way to "fluoro" your catheter, and much more.
Podcast: Play in new window | Download (Duration: 29:37 — 24.1MB)
Subscribe: RSS
In this episode, we again explore the world of the distal perfusion catheter. You heard from Joe Dubose the vascular surgeons point of view; now let’s see how non-surgeon resuscitationists are dealing with this problem. You will hear from Chris Couch, a critical care trained emergency physician from Dallas Texas and his colleague Omar Hernandez who have some novel thoughts and experiences related to when and how we insert these catheters. You will hear about checking compartment pressures, poor man’s way to “fluoro” your catheter, and much more.
Great summary of supporting literature – DPC Lit Search
These last two podcasts have been great discussions. The subject of whether all patients need a distal perfusion cannula was lightly discussed on the last podcast. I agree that most eCPR patients (not all) will tend to need one, particularly if they don’t wake up immediately and you can’t follow an exam.
At my institution (the University of New Mexico) we do a fair number of awake cannulations in the ED and the ICU; particularly in patients with massive PE’s. We do primary VA ECMO for them (we try to avoid thrombolytics and intubation), and they often go from arrest/peri-arrest before the cannulation to watching football and eating dinner a couple of hours after.
If we don’t cannulate awake, we try to wake them up and extubate them as soon as we can. If they’re awake, we follow their exams closely, and if they don’t have too much leg pain and have a good lower extremity NV exam, we don’t put a DPC in. We have done it this way for about 2 and a half years or so. I have been surprised by how often it isn’t needed, and the patients are saved from having the extra procedure because we made keeping them awake a priority.